Ohio emergency rooms confront 'doctor shopping'

Addicts use tactic to obtain pain relievers

Apr. 17, 2013

Written by

Russ Zimmer

CentralOhio.com

Emergency room doctors at a suburban Toledo hospital knew certain patients would cruise through the ER with faked or exaggerated symptoms to score prescription pain relievers, but they had no idea to what extent “doctor-shopping” was taking place.

They set out to quantify the problem in 2009 by tracking patients who frequented the emergency room at St. Luke’s Hospital and then to identify which of those exhibited “drug-seeking” behavior, said Rick Quinlin, risk manager at St. Luke’s. Early returns showed about 19 or 20 regulars, and that seemed like a lot to Quinlin, who soon learned they were only “a drop in the bucket.”

“By the end of 2009 we had 289 patients that we’ve identified, and as of today, we have 1,234,” he said. At least 17 of those individuals have died, he said, but it was unclear whether drug overdoses were the causes.

During 2010, 1,544 Ohioans died of an unintentional drug overdose. More recent data are not yet available, according to the Ohio Department of Health. Prescription opioids, such as Percocet or Vicodin, were named on 45 percent of those death certificates in 2010.

For an idea of how bad the situation had deteriorated, compare those casualties with those sustained on the road. Traffic crashes, which traditionally had been the top cause of injury deaths in the state, killed 1,080 in Ohio that same year.

As a response to rising death tolls from the misuse of prescription medication, particularly opioids, the state and its medical community are undergoing an overhaul of how they track, regulate and dispense these drugs.

One of those changes was the adoption in 2012 of prescribing guidelines for emergency rooms and urgent care centers, which have long been popular targets for doctor-shopping because of the hustle and bustle of the urgent care setting and the lack of a relationship between doctor and patient.

The state health department invited Quinlin and Dr. Dawn Prall, an ER doctor at Mt. Carmel St. Ann’s northeast of Columbus, to share what has worked regarding implementation of the guidelines Tuesday morning for their colleagues.

At least eight hospital systems have put some version of the guidelines in place, according to the state health department.

Prall noted that almost 1 in 2 American adults is living with chronic pain and that prescribers shouldn’t lose sight of that.

“You shouldn’t avoid prescribing controlled substances, but when you do, have good reasons,” she said.